Individual
BERRY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2746
(708) 422-4221
(708) 422-4415
Mailing address
9204 S PLEASANT AVE, CHICAGO, IL 60620-5513
(708) 422-4221
(708) 422-4415
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036075439
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036075439
IL
Other
Enumeration date
12/02/2005
Last updated
09/21/2016
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